| 摘要: |
| 目的 探索胸背部膜椎韧带（meningovertebral ligaments）的性状和临床意义。方法 取正常成人胸椎防腐标本，自两侧椎弓根处打开椎管，在肉眼和手术显微镜下观察韧带形态、走行方向、附着点位置和分布特点。用游标卡尺在手术显微镜下测量其长度、宽度或直径及厚度。结果 胸椎硬脊膜背部膜椎韧带将硬脊膜连于黄韧带或椎板。膜椎韧带在胸椎，特别上胸椎水平即第1胸椎～第7胸椎（T1～T7），分布相对较均匀；在下胸椎水平即第7胸椎～第12胸椎（T7～T12），韧带的出现率自上向下呈上升趋势。膜椎韧带在黄韧带上出现率明显高于椎板。韧带的长、宽、厚无明显阶梯性或节段性规律。韧带长度多变，5.45~31.11 mm，最宽2.70 mm，最厚0.49 mm。同一节段韧带以1束者居多，呈前上后下走行，质地较为坚韧。膜椎韧带向前延入硬脊膜成为硬脊膜的一部分。部分韧带有血管伴行或与血管相连。膜椎韧带形态有4种类型即条带型、条索型、"Y"字型、薄片型。结论 胸椎硬脊膜背部与黄韧带及椎板间有正常连接的膜椎韧带。根据其解剖特点，膜椎韧带可能是造成胸椎后路减压手术中出现硬脊膜撕裂和硬脊膜外出血的解剖学原因，建议术中先行辨认并妥善处理，以最大程度减少相关并发症的发生。 |
| 关键词: 解剖学 胸椎 膜椎韧带 硬脊膜撕裂 |
| DOI：10.11724/jdmu.2019.05.03 |
| 分类号:R322.7 |
| 基金项目: |
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| Anatomic study and clinical significance of dorsal meningovertebral ligaments of the thoracic dura mater |
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CHEN Rongzi1, CHEN Peiji1, CHEN Kun1, ZHENG Wenzhong1, ZHANG Hui2
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1. Department of Orthopaedics, No. 910 Hospital of PLA, Quanzhou 362000, China;2. Department of Spinal Surgery, Guangdong Second People's Hospital, Guangzhou 510317, China
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| Abstract: |
| Objective To investigate the properties and clinical significance of dorsal meningovertebral ligaments of the thoracic dura mater. Methods Eighteen adult embalmed cadavers were studied, and the morphology, orientation, attachment site, and distribution traits of the dorsal meningovertebal ligaments were observed. In addition, the length, width, or diameter and thickness of the ligaments were measured using a Vernier caliper. Results In the thoracic region, the dorsal meningovertebral ligaments anchored the dura mater to the lamina or ligamentumfl avum. The meningovertebral ligaments displayed a relatively even distribution along the upper thoracic region (T1-T7) and a gradual increase in frequency in the lower thoracic region from T7 to T12. The meningovertebral ligaments protruded into the dura and correspondingly became an integral part of the dura. Some ligaments were accompanied by or were attached to blood vessels. Conclusion The dorsal meningovertebral ligaments exist between the dural sac and ligamentumfl avum or lamina in the thoracic spine. Based on their anatomic features, meningovertebral ligaments may be one potential cause for dural laceration and epidural hemorrhage. We propose that, during thoracic flavectomy and laminectomy, the meningovertebral ligaments should first be identified and properly handled, thereby minimizing the occurrence of relevant complications. |
| Key words: anatomy thoracic vertebra meningovertebral ligaments dural laceration |
